A growing number of Democratic lawmakers in Congress are pushing the single-payer (“Medicare for all”) approach to health care.
But Republicans’ experience on the issue over the past several years should provide a warning to Democrats about the dangers of overpromising on something as complicated as health care transformation.
For years, Republican lawmakers talked boldly and incessantly about how, if given control of Congress and the White House, they would toss out Obamacare and replace it immediately with a smartly designed replacement that people would like.
President Donald Trump has eagerly promoted such expectations, both as a candidate and as chief executive. The GOP plan, he said, would be “something terrific.”
But as the whole country saw this year, the GOP’s big promises ran headlong into huge, real-world complications.
The Congressional Budget Office said the Republican proposal would mean the loss of coverage for millions of Americans. Such findings spurred public angst and led in part to the proposal’s failure in the Senate this summer.
This experience shows that elected leaders of both parties can serve the public interest best if they level with the public, from the start, about the practical difficulties of undertaking sweeping health care overhauls.
A key obstacle with single-payer is the enormous cost. Individuals and companies would no longer pay directly for health insurance, but new taxes on an immense scale would be needed to fund government-run coverage, reducing any benefit from private-sector savings.
The increase in government spending for the first 10 years would total $32 trillion, according to the Urban Institute, a left-leaning think tank. For perspective, consider that the current total national debt is $20 trillion.
It’s argued that most Europeans accept the high taxes required for such government benefits, and that’s correct.
But the political culture in the United States is different, with far less tolerance for taxes at European levels. Look at politically blue states such as Massachusetts, Maryland and New Jersey — over the past decade, public anger over tax increases under Democratic gubernatorial administrations led to the election of Republican governors in all three states.
It’s legitimately noted that health care spending per capita is less in European countries with universal coverage. Per capita spending is dependent on many factors beyond health insurance structuring, however. Our country’s high rates of obesity and smoking, for example, unfortunately are strong factors boosting our per capita rate.
A second big obstacle: the huge political and logistical problems in ending the traditional employer-based insurance coverage that millions of Americans currently have and for the most part support.
Jonathan Chait, a longtime liberal commentator, summed up the problem in an article last week for the Atlantic magazine:
“The barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare. That is not a detail to be worked out. It is the entire problem. . . . Health care experts have spent decades trying to grapple with this dilemma.”
These issues — the mind-boggling cost of such a system and the complications of ending employer-based health coverage — pose major obstacles to a single-payer approach. Democratic leaders would do well not to sidestep these realities.
Smaller-scale, incremental changes to our country’s health care system may not be politically splashy, but such prudence — by both parties — is amply justified.
It’s encouraging that some members in the Senate are now pursuing a more pragmatic approach.
Irresponsible overpromising, in contrast, sets up the public for major disappointment and a political party for painful embarrassment. Just ask the Republicans.